Atrial fibrillation: paroxysmal, chronic: amiodarone prevented reversion better than sotalol following cardioversion.

Clinical bottom line (level 1b)

  1. Patients with symptomatic paroxysmal or chronic atrial fibrillation who took amiodarone compared with sotalol after cardioversion were more likely to be in sinus rhythm (NNT = 3 at 12 months) .
  2. There was no clear difference in the number of adverse effects which led to withdrawal of medication.
Kochiadakis et al: American Journal of Cardiology 1998; 81: 995-998
Expires November 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: university hospital, Greece

70 patients (aged mean 63 years, 56% male) paroxysmal atrial fibrillation (70%) (recurrent self-terminating episodes lasting < 48 hours, alternating with periods of sinus rhythm) or chronic AF (continuous) and symptoms (light-headed, palpitation, chest pain or dyspnoea)

Excluded if
  • <18 years old
  • no ECG evidence of AF
  • acute MI within 7 days
  • cardiogenic shock
  • transient AF due to pneumonia, PE, recent heart surgery or uncontrolled heart failure
  • unstable hepatic or renal function
  • ejection fraction < 40%
  • hyperthyroidism
  • life expectancy < 1 year
  • unsuccessful cardioversion


    • Note:
  • All patients were cardioverted. This was repeated as necessary during the loading phase.


    • Control Group: (n = 35, 35 analysed): sotalol 80 mg bd po increased by 40 to 80 mg every 48 to 72 hours until maximum of 360 mg (dose reduced if adverse effects or rate-corrected QT interval > 0.5 sec).
    Experimental Group: (n = 35, 35 analysed): amiodarone 800 to 1600 mg po daily for 7 to 14 days, then tapered over 7 to 12 days to usually 200 mg od.

    100% followed for 12 months

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    recurrence of AF 12 months 21
    (60.0%)    		 10
    (28.6%)    		 52%
    (14% to 74%)    		 31.4%
    (9.35% to 53.5%)    		 3
    (2 to 11)
    adverse effects requiring withdrawal 12 months 3
    (8.57%)    		 2
    (5.71%)    		 33%
    (-275% to 88%)    		 2.86%
    (-9.19% to 14.9%)    		 35
    (NNT = 7 to infinity;
    NNH = 11 to infinity)

  • adverse effects requiring withdrawal: amiodarone - 2 with hyperthyroidism; sotalol - 2 with bradycardia, 1 with CNS effects

    • Citation

    1. Kochiadakis GE, Igoumenidis NE, Marketou ME, et al: Low-dose amiodarone versus sotalol for suppression of recurrent symptomatic atrial fibrillation. American Journal of Cardiology 1998; 81: 995-998
    Search Terms: atrial fibril* in Cochrane
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer:

    Clinical Question.
    Patient AF
    Intervention or Exposure amiodarone
    Comparison sotalol
    Outcome recurrence, side effects